VN June 2020

Vetnews | June 2020 7 >>> 8 The COVID-19 pandemic has had a major impact on our lives. Even after the lockdown regulations were relaxed somewhat with the implementation of level 4, we still have to keep our distance from other people and put measures in place to protect them and us during consultations. Most practices only allow one person per animal into the practice facilities, and some use staff to hold animals with the owners in the background, or sometimes not present at all. In South Africa, as almost everywhere else in the world, the physical hands-on examination of a patient is regarded as the starting point of any veterinary-client- patient-relationship. Without this, one cannot make a diagnosis or prescribe treatment. When the lockdown was announced, we were told to limit veterinary services to emergencies only, and to postpone visits by clients to our practices to a later date if possible. This brought some questions. How do you decide on whether a case is an emergency or can be postponed? And for those that do not need immediate treatment, what can be done? The first question remains largely unanswered. Pictures, video clips and client reports often are lacking. Some clients are less observant than others, and will not be able to provide much information, not even on how long the problem was ongoing. The diarrhoea that was only seen this morning could require intensive treatment tomorrow. Is it in the best interest of the patient to be given some basic off-the-shelf medicine that will not cure the problem and might just prolong suffering? Many countries across the world made a ruling allowing veterinarians to deal with some cases without a physical examination. The SAVC did the same, and I quote: “It is less than ideal to conduct telephonic consults and to dispense subsequent medication based on such a consult. That said, however, this is a situation that could not have been anticipated, hence the rules do not provide for it. While a physical examination is best practice and the preferred method of making a diagnosis, you can justify a telephonic consultation at the hand of the prevailing circumstances, should a complaint be received. To safeguard yourself, you are advised to explicitly inform the client that you cannot make a definitive diagnosis based on a telephonic consultation, which may include photographs and/or video clips and that the client be made aware of the inherent risk. Keep detailed clinical notes of these discussions with your client, or better yet, get it down on paper/in writing (e-mail, WhatsApp or SMS which could be printed for your records). You will have to use your informed discretion and knowledge as a veterinarian to deal with each request on its own merit and to know when a physical examination is the only way to reach a diagnosis, i.e. triage. Should a complaint be received, it will be considered on its own merit, having regard for the prevailing circumstances (a declared national disaster), which is not provided for in the rules for the veterinary profession. Under the circumstances, deviation from some of the rules, may be justified.” Leading Article Telehealth in Veterinary Practice Dr Paul van Dam